436例脑梗死合并心房颤动住院患者抗血栓药应用分析  

Analysis on Application of Antithrombotic Drugs for 436 Patients with Ischemic Stroke and Atrial Fibrillation

作　　者：沈洁[1] 赖剑锋[1] SHEN Jie;LAI Jianfeng(Dept.of Pharmacy,the First Hospital of Longyan Affiliated to Fujian Medical University,Fujian Longyan 364000,China)

机构地区：[1]福建医科大学附属龙岩市第一医院药剂科,福建龙岩364000

出　　处：《中国医院用药评价与分析》2018年第8期1107-1109,共3页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:了解福建医科大学附属龙岩市第一医院(以下简称"我院")脑梗死合并心房颤动住院患者抗血栓药的使用情况及合理性,为促进合理用药提供参考。方法:采用回顾性分析方法,收集2013年1月至2017年6月我院神经内科收治的436例脑梗死合并心房颤动患者的人口学数据、临床特征、美国国立卫生院卒中神经功能缺损评分量表(national institutes of health stroke scale,NIHSS)评分、心房颤动患者卒中风险评分(CHA2DS2-VAS)、出血风险评分(HAS-BLED)及出院时改良Rankin量表(modified rankin scale,mRS)评分,同时对抗血栓药使用情况进行统计分析,评估用药合理性。结果:436例患者使用了华法林、阿司匹林、氯吡格雷及阿司匹林联合氯吡格雷等抗栓治疗,其中单独使用华法林、阿司匹林的患者占多数。与单独使用阿司匹林患者相比,单独服用华法林的患者较年轻,平均年龄(67.00±10.79)岁。单独使用华法林、阿司匹林患者的NIHSS评分[(7.20±6.73)分vs.(9.60±7.47)分]、CHA2DS2-VAS评分[(4.23±1.30)分vs.(5.11±1.39)分]、改良Rankin评分[(1.80±1.50)分vs.(2.34±1.66)分]的差异均有统计学(P<0.05)。结论:我院神经内科脑梗死合并心房颤动患者的抗栓治疗方案欠合理。医师在选择治疗方案时,多受到患者年龄、并发症、脑梗死严重程度及出院后自理能力等因素的影响。临床药师应加强药学服务,进一步优化抗栓治疗方案,加强医患对抗凝治疗的认识。OBJECTIVE： To investigate the application status and rationality of antithrombotic drugs for inpatients with ischemic stroke and atrial fibrillation in the First Hospital of Longyan Affiliated to Fujian Medical University（ hereinafter referred to as ＂our hospital＂）,so as to provide reference for the rational drug use. METHODS： General information of 436 patients with ischemic stroke,atrial fibrillation admitted into Jan. 2013 to Jun. 2017 were collected,in terms of demographic data,clinical features,national institutes of health stroke scale（ NIHSS）,stroke risk score（ CHA2DS2-VAS）,bleeding risk score（ HAS-BLED）,modified rankin scale（ mRS） after discharge; and the application status of antithrombotic drugs was statistically analyzed; and the rationality of drug application was evaluated. RESULTS：436 patients were treated with antithrombotic therapy such as warfarin,aspirin,clopidogrel,and aspirin combined with clopidogrel,of which the majority of the patients were warfarin and aspirin. Compared with patients taking aspirin alone,patients treated with warfarin alone were younger,with an average age of（ 67. 00 ± 10. 79） years. The differences of NIHSS score[（ 7. 20 ± 6. 73） points vs.（ 9. 60 ± 7. 47） points ],CHA2DS2-VAS score [（ 4. 23 ± 1. 30） points vs.（ 5. 11 ±1. 39） points]and improved Rankin score[（ 1. 80 ± 1. 50） points vs.（ 2. 34 ± 1. 66） points]were statistically significant in patients treated with warfarin alone（ P〈0. 05）. CONCLUSIONS： The antithrombotic scheme for patients with ischemic stroke and atrial fibrillation is not rational in our hospital. Physicians are more likely to be affected by factors such as age,complications,severity of cerebral infarction,and self-care ability after discharge. It is necessary for clinical pharmacists to strengthen pharmaceutical care,further optimize the antithrombotic regimen,and strengthen the understanding of the treatment of doctor-patient anticoagulant therapy.

关 键 词：心房颤动 脑梗死 华法林 阿司匹林 抗血栓药 

分 类 号：R972[医药卫生—药品]